MEDICARE: SOMERSET BERKLEY REGIONAL SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		MA

General Provider Information

NPI Number	:	1548543911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMERSET BERKLEY REGIONAL SCHOOL

Provider Business Mailing Address
First Line	:	580 WHETSTONE HILL RD
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-3702
Country	:	US
Telephone Number	:	508-324-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 WHETSTONE HILL RD
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-3702
Country	:	US
Telephone Number	:	508-324-3100
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MRS. CATHERINE ANTONELLIS
Credential	:
Telephone Number	:	508-324-3100

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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